=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487064424
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | YEON JOUNG ELEBIARY FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/29/2014
-----------------------------------------------------
Last Update Date | 03/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 46 BRENTWOOD RD
-----------------------------------------------------
City | BAY SHORE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11706-6924
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-647-3800
-----------------------------------------------------
Fax | 631-968-3749
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 23 ORCHID LN
-----------------------------------------------------
City | NEW HYDE PARK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11040-1917
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-417-4905
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WM0705X
-----------------------------------------------------
Taxonomy Name | Medical-Surgical Registered Nurse
-----------------------------------------------------
License Number | 592766
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | F338581-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------